This week’s blog on Retinal Detachment has been contributed by Dr Igor Kozak, Consultant Ophthalmologist, specialist in Vitreoretinal Surgery, Medical Retina and Uveitis.
Retinal detachment is a condition when the most light-sensitive layer of the human eye, the retina, is separated from its underlying structures. This is associated with decrease in vision.
Various causes lead to such separation, such as forceful traction of the vitreous causing a retinal break, contraction of the membranes that can grow on top of the retina or inflammation causing accumulation of fluid under the retina.
The treatment should start immediately. When untreated, retinal detachment usually causes permanent vision loss due to death of light sensitive cells – photoreceptors. These cells cannot regenerate and, therefore, retinal detachment represents a serious, vision threatening condition.
Treatment should address underlying mechanism causing the detachment. If mechanical causes such as trauma or membrane contraction lead to retinal detachment, then reattachment surgery is the standard of care. The technique of scleral buckle uses silicone band to be placed externally on the eye. Another surgical approach is from inside the eye and is called pars plana vitrectomy. In this technique, a small opening is made in the eye for infusion, light and vitrectomy probe. The gel inside the eye, the vitreous, is removed and retinal break causing the detachment is identified and sealed, usually with laser. A tamponading agent is placed in the eye to keep retina attached until the causative break is completely sealed. This can be either intraocular gas or silicone oil. In general, post-operative recovery in retinal surgery is usually longer that in other ophthalmic surgeries given the complexity of retinal anatomy and surgical techniques we use. Topical therapy is used after retinal surgery for some time.
In cases of inflammation causing fluid exudation, the potent anti-inflammatory therapy is the treatment of choice. The amount of fluid under the retina can be monitored using imaging technology.